Aortic Valve: Difference between revisions

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==Anatomy==
==Anatomy==
The normal aortic valve consists of three equally sized valve cusps (in English "cusps"), namely the right coronary cusp (R), the left coronary cusp (L) and the non-coronary cusp (N).
The normal aortic valve consists of three equally sized valve cusps, namely the right coronary cusp (R), the left coronary cusp (L) and the non-coronary cusp (N).


[[Image:Aovalv.png]]
[[Image:Aovalv.svg|300px]]


With 2D echocardiography, the valve can be assessed in the Plax, where one sees the RCC and the NCC. In a normal aortic tricuspid valve closure line is then between the RCC and NCC is usually in the center of the aortic valve ring. Better one sees the aortic valve in the PSAXao However, where the three cusps in systole almost form a circle and diastole in an inverted Mercedes-Benz logo. Assessing the number of cusps is done in systole, because the valve is open, because in the closed position can be seen as a raphe purse line. With 3D echocardiography is now also wonderful to images. Off the aortic valve
With 2D echocardiography, the valve can be assessed in the PLAX, where one sees the RCC and the NCC. In a normal aortic tricuspid valve, the closure line is between the RCC and NCC and usually in the center of the aortic valve ring. However, the aortic valve can be even better assessed in the PSAXao, where the three cusps in systole almost form a circle and in diastole an inverted Mercedes-Benz logo. Assessing the number of cusps is done in systole, because the valve is open and because in the closed position raphes can be misinterpreted. With 3D echocardiography you can now also get wonderful images of the aortic valve.


{| class="wikitable" cellpadding="0" cellspacing="0" border="0"
{| class="wikitable" cellpadding="0" cellspacing="0" border="0"
|-
|Video
|-
|-
!3D (TEE) view of the aortic valve to exclude vegetations.
!3D (TEE) view of the aortic valve to exclude vegetations.
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==Aortic valve variants (PLAX ao)==
==Aortic valve variants (PLAX ao)==


{| class="wikitable" cellpadding="0" cellspacing="0" border="0"
{| class="wikitable" cellpadding="0" cellspacing="0" border="0" width="600px"
|-
|Video
|Video
|-
|-
!Tricuspid (normal)  
!Tricuspid (normal)  
!Bicuspid
!Bicuspid
|-
|Video
|Video
|-
|-
!Quadricuspide  
!Quadricuspide  
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|}
|}


Bicuspid aortic valve
==Bicuspid aortic valve==
Bicuspid aortic valve is the most common cardiac valve abnormality. Here are two leaflets fused at the development. A bicuspid aortic valve occurs in 1-2% of the population and twice as often in men as in women.
The bicuspid aortic valve is the most common cardiac valve abnormality. Here are two leaflets fused during the development. A bicuspid aortic valve occurs in 1-2% of the population and twice as often in men compared to women.
A bicuspid aortic valve can be hereditary, both familial clustering and isolated valve defects are documented. The incidence of bicuspid aortic valve may reach 10% in certain families. A bicuspid aortic valve is often associated with other congenital heart defects, including coarctation of the aorta. Usually there is a fusion between the LCC and RCC (70%). In many cases, the bicuspid aortic valve do not cause any problems. Later in life, the valve will calcify early causing a stenosis occurs and possibly leak through malcoaptatie of the affected cusps.
 
A bicuspid aortic valve can be hereditary, both familial clustering and isolated valve defects are documented. The incidence of bicuspid aortic valve may reach 10% in certain families. A bicuspid aortic valve is often associated with other congenital heart defects, including coarctation of the aorta. Usually there is a fusion between the LCC and RCC (70%). In many cases, the bicuspid aortic valve does not cause any problems. Later in life, the valve will calcify early causing a stenosis and possibly also regurgitation through malcoaptation of the affected cusps.


==Stenosis==
==Stenosis==


causes
{| class="wikitable" cellpadding="0" cellspacing="0" border="0" width="700"
Supravalvulair (usually congenital)
|-
 
|colspan="2"|'''Causes'''
A pleat or membrane of the aorta
|-
Narrowing of the aorta
|'''Supravalvulair:'''
Williams Syndrome
(usually congenital)
valvular:
|
Congenital form; often than bicuspid aortic valve
*A pleat or membrane of the aorta
Due to rheumatic fever
*Narrowing of the aorta
degenerative form
*William's Syndrome
subvalvular:
|-
Congenital anomaly: a membrane in LVOT
|'''Valvular:'''
Hypertrophic obstructive cardiomyopathy, an autosomal dominant hereditary disorder
|
Aortic subvalvular stenosis has also been described as a result of any of the lysosomal storage diseases
*Congenital form; often bicuspid aortic valve
*Due to rheumatic fever
*Degenerative form
|-
|'''Subvalvular:'''
|
*Congenital anomaly: a membrane in LVOT
*Hypertrophic obstructive cardiomyopathy, an autosomal dominant hereditary disorder
*Aortic subvalvular stenosis has also been described as a result of lysosomal storage diseases
|}


Some patients have no symptoms, sudden, unexpected death, the first phenomenon. Fatigue, shortness of breath and lack of oxygen during exertion, chest pain and dizziness and fainting during exercise are further symptoms. The left ventricle must be at a higher pressure aortic valve stenosis in order to generate gain. Blood in the aorta Arises in the long run by left ventricular pressure load. Depending on the severity and cause of the problem, a valve replacement may be indicated.
Some patients have no symptoms, but sudden, unexpected death may be the first phenomenon. Fatigue, shortness of breath and lack of oxygen during exertion, chest pain and dizziness and fainting during exercise are other symptoms. The left ventricle must develop higher pressures in aortic valve stenosis in order to generate an adequate blood pressure. Depending on the severity and cause of the problem, a valve replacement may be indicated.


Click [[Aortic Valve Stenosis|'''here''']] for quantification of aortic valve stenosis.
Click [[Aortic Valve Stenosis|'''here''']] for quantification of aortic valve stenosis.
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==Insufficiency==
==Insufficiency==


causes
{| class="wikitable" cellpadding="0" cellspacing="0" border="0" width="700"
congenital
|-
Bicuspid aortic valve
|colspan="2"|'''Causes'''
Risk of damage to the aortic valve
|-
rheumatic fever
|'''Congenital'''
degeneracy
|
endocarditis
*Bicuspid aortic valve
syphilis
|-
trauma
|'''Risk of damage to the aortic valve'''
Metabolic diseases, such as the mucopolysaccharidosen
|
aortic dilation
*Rheumatic fever
connective tissue disease, such as Marfan's syndrome, Ehlers-Danlos syndrome,
*Degeneracy
aneurysm by inflammation, such as syphilis, vasculitis.
*Endocarditis
aneurysm atherosclerotic lesions in aorta
*Syphilis
aortic dissection
*Trauma
*Metabolic diseases, such as the mucopolysaccharidosen
|-
|'''Aortic dilation'''
|
*Connective tissue disease, such as Marfan's syndrome, Ehlers-Danlos syndrome,
*Aneurysm by inflammation, such as syphilis, vasculitis.
*Aneurysm atherosclerotic lesions in aorta
*Aortic dissection
|}


A serious aortic regurgitation caused a volume overload of the left ventricle. Since the blood that has been pumped out, it must be pumped out, once again touches the left ventricular overload and heart failure occurs. Patients complain of fatigue and shortness of breath. The valve, and possibly a part of the aortic arch, can be replaced.
A serious aortic regurgitation causes a volume overload of the left ventricle. Since the blood that has just been ejected, returns immediately and causes left ventricular overload and subsequently heart failure may occur. Patients complain of fatigue and shortness of breath. The valve, and possibly a part of the aortic arch, may be replaced.


Click [[Aortic Valve Insufficiency|'''here''']] for quantification of aortic valve insufficiency.
Click [[Aortic Valve Insufficiency|'''here''']] for quantification of aortic valve insufficiency.
==External links==
* [https://www.techmed.sk/en/echo/aortic-valve/ Aortic valve - all measurements (TECHmED)]

Latest revision as of 14:09, 9 January 2021

Anatomy

The normal aortic valve consists of three equally sized valve cusps, namely the right coronary cusp (R), the left coronary cusp (L) and the non-coronary cusp (N).

Aovalv.svg

With 2D echocardiography, the valve can be assessed in the PLAX, where one sees the RCC and the NCC. In a normal aortic tricuspid valve, the closure line is between the RCC and NCC and usually in the center of the aortic valve ring. However, the aortic valve can be even better assessed in the PSAXao, where the three cusps in systole almost form a circle and in diastole an inverted Mercedes-Benz logo. Assessing the number of cusps is done in systole, because the valve is open and because in the closed position raphes can be misinterpreted. With 3D echocardiography you can now also get wonderful images of the aortic valve.

Video
3D (TEE) view of the aortic valve to exclude vegetations.

Aortic valve variants (PLAX ao)

Video Video
Tricuspid (normal) Bicuspid
Video Video
Quadricuspide Unicuspide

Bicuspid aortic valve

The bicuspid aortic valve is the most common cardiac valve abnormality. Here are two leaflets fused during the development. A bicuspid aortic valve occurs in 1-2% of the population and twice as often in men compared to women.

A bicuspid aortic valve can be hereditary, both familial clustering and isolated valve defects are documented. The incidence of bicuspid aortic valve may reach 10% in certain families. A bicuspid aortic valve is often associated with other congenital heart defects, including coarctation of the aorta. Usually there is a fusion between the LCC and RCC (70%). In many cases, the bicuspid aortic valve does not cause any problems. Later in life, the valve will calcify early causing a stenosis and possibly also regurgitation through malcoaptation of the affected cusps.

Stenosis

Causes
Supravalvulair:

(usually congenital)

  • A pleat or membrane of the aorta
  • Narrowing of the aorta
  • William's Syndrome
Valvular:
  • Congenital form; often bicuspid aortic valve
  • Due to rheumatic fever
  • Degenerative form
Subvalvular:
  • Congenital anomaly: a membrane in LVOT
  • Hypertrophic obstructive cardiomyopathy, an autosomal dominant hereditary disorder
  • Aortic subvalvular stenosis has also been described as a result of lysosomal storage diseases

Some patients have no symptoms, but sudden, unexpected death may be the first phenomenon. Fatigue, shortness of breath and lack of oxygen during exertion, chest pain and dizziness and fainting during exercise are other symptoms. The left ventricle must develop higher pressures in aortic valve stenosis in order to generate an adequate blood pressure. Depending on the severity and cause of the problem, a valve replacement may be indicated.

Click here for quantification of aortic valve stenosis.

Insufficiency

Causes
Congenital
  • Bicuspid aortic valve
Risk of damage to the aortic valve
  • Rheumatic fever
  • Degeneracy
  • Endocarditis
  • Syphilis
  • Trauma
  • Metabolic diseases, such as the mucopolysaccharidosen
Aortic dilation
  • Connective tissue disease, such as Marfan's syndrome, Ehlers-Danlos syndrome,
  • Aneurysm by inflammation, such as syphilis, vasculitis.
  • Aneurysm atherosclerotic lesions in aorta
  • Aortic dissection

A serious aortic regurgitation causes a volume overload of the left ventricle. Since the blood that has just been ejected, returns immediately and causes left ventricular overload and subsequently heart failure may occur. Patients complain of fatigue and shortness of breath. The valve, and possibly a part of the aortic arch, may be replaced.

Click here for quantification of aortic valve insufficiency.

External links